Acute management of dengue shock syndrome: A randomized double-blind comparison of 4 intravenous fluid regimens in the first hour
Acute management of dengue shock syndrome: A randomized double-blind comparison of 4 intravenous fluid regimens in the first hour
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DOI：
10.1086/318479
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发表时间：
2001-01-15
影响因子：
11.8
通讯作者：
Farrar, J
中科院分区：
文献类型：
--
作者：
Nhan, NT;Phuong, CXT;Farrar, J
登革出血热是亚洲儿童发病的重要原因，更严重的登革休克综合征（DSS）导致大量儿童死亡。DSS的特征是全身毛细血管通透性的大量增加，随后出现血容量不足。液体复苏是至关重要的，但迄今为止还没有大型试验来确定最佳的液体方案。我们对230名越南DSS儿童进行了4种液体（右旋糖酐、明胶、乳酸林格氏液和生理盐水）的初始复苏随机盲法比较。所有儿童均存活，使用4种液体中的任何一种都没有明显的优势，但乳酸林格氏液组的恢复时间最长。决定临床反应的最重要因素是就诊时的脉压。胶体和晶体组的比较表明，接受其中一种胶体治疗的脉压较低的儿童受益。进一步的大规模研究，分层入院脉压，指出。
Dengue hemorrhagic fever is an important cause of morbidity among Asian children, and the more severe dengue shock syndrome (DSS) causes a significant number of childhood deaths. DSS is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia. Fluid resuscitation is critical, but as yet there have been no large trials to determine the optimal fluid regimen. We undertook a randomized blinded comparison of 4 fluids (dextran, gelatin, lactated Ringer's, and "normal" saline) for initial resuscitation of 230 Vietnamese children with DSS. All the children survived, and there was no clear advantage to using any of the 4 fluids, but the longest recovery times occurred in the lactated Ringer's group. The most significant factor determining clinical response was the pulse pressure at presentation. A comparison of the colloid and crystalloid groups suggested benefits in children presenting with lower pulse pressures who received one of the colloids. Further large-scale studies, stratified for admission pulse pressure, are indicated.